The Clinical Significance of Poor Bladder Compliance

Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.
Neurourology and Urodynamics (Impact Factor: 2.87). 11/2009; 28(8):1010-4. DOI: 10.1002/nau.20713
Source: PubMed


There is limited data on bladder compliance associated with lower urinary tract dysfunction. The aim of this study was to investigate the decrease in bladder compliance, and the clinical relationship between patterns of increased pressure with neurological disease.
A retrospective analysis was performed in 5,027 patients with voiding dysfunction between June 2002 and April 2008. The patients with poor compliance (PC) were categorized according to the detrusor pattern of increased pressure: group A (gradual increase), group B (terminal increase), and group C (abrupt increase and plateau).
Patients with PC were found in 170 (3.4%) cases (76 males and 94 females) with 46.5% in group A 44.7%, group B, and 8.8% group C. Bladder trabeculation was more prevalent in patients with PC than among those with normal compliance. Group A had the highest correlation with the incidence of spinal cord injury compared to the other groups. Group B had a higher correlation with a history of pelvic irradiation, radical prostatectomy, and tethered cord syndrome compared to the others. Vesicoureteral reflux was more frequently detected in group A and group C. Group C was positively correlated with the presence of detrusor overactivity and nocturnal enuresis.
Poor compliance was correlated with the presence of neurological conditions. The gradual increase of detrusor pressure was associated with the development of spinal cord injury, and the terminal increase had an association with a history of treatment to the pelvic cavity.

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    • "Briefly, it was derived from EAS EMG and was expressed as [lg (potentials before voiding/at Qmax)] with a negative number (<0) indicating that the sphincter activity was abnormally increased during voiding. The detrusor contraction fashion in DUA-NC was low sustained (Fig. 3a), whereas those in DUA-LC was high sustained as the Pdet had reached a relatively high level prior to ordering voiding and did not increase during the voiding phase (Fig. 4a) [12, 13]. If effective detrusor contraction pressure was claimed, the Pdet ahead of the voiding order should be subtracted from the real-time Pdet. "
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